Benign Brain and Central Nervous System Tumors by A
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GCCR Register Georgia Comprehensive Cancer Registry Spring 2004 Benign Brain and Central Nervous System Tumors By A. Rana Bayakly, GCCR Director Based on NAACCR 2004 Implementation Guidelines www.naaccr.org Benign brain and central nervous program) to collect both benign and Casefinding- Hospital casefinding system tumors (CNS) are deadly because of malignant CNS tumors. list should now include the following ICD- their location and their impact on the brain. Commission on Cancer (COC) and 9-CM codes to identify all the potential Although often removable, they may result the Surveillance Epidemiology and End cases: in death, paralysis, blindness and other Results (SEER) added benign CNS tumors • 225.0 Benign neoplasm of brain brain damage. to their case definition as of January 1, • 225.1 Benign neoplasm of cranial Malignant CNS tumors are the 2004. Georgia reporting mandate was nerves second most common cancer in children, changed to add benign CNS tumors to the • 225.2 Benign neoplasm of cerebral accounting for 23% of all childhood cancers reportable list for all cases diagnosed on meninges; cerebral meningioma death in Georgia. They also are the third January 1, 2004 and later. • 225.3 Benign neoplasm of spinal leading cancer cause of death in young In Georgia any tumor diagnosed cord, cauda equina adults aged 15-34 in the United States and on January 1, 2004 or later with a behavior • 225.4 Benign neoplasm of spinal Georgia. code of ‘0’ or ‘1’ is reportable for the meninges; spinal meningioma The number of benign CNS tumors following Site Codes (ICD-O-3): • 225.8 Benign neoplasm of other diagnosed in Georgia each year is unknown, Meninges C70.0 – C70.9; Brain C71.0 – specified sites of nervous system but is thought to be similar to the number of C71.9; Spinal Cord, cranial nerves, and • 225.9 Benign neoplasm of nervous malignant CNS tumors. other parts of the Central nervous System system, part unspecified Meningioma, a “benign” brain C72.0 – C72.9; Pituitary gland C75.1; • 227.3 Benign neoplasm of pituitary, tumor that accounts for one-fourth to one- Craniopharyngeal duct C75.2; and Pineal craniopharyngeal duct, craniobuccal third of all brain cancers, is more deadly gland C75.3. Histology codes are based on pouch, hypophysis, Rathke’s pouch, than breast cancer. Thirty-one percent the ICD-O-3 book. Juvenile astrocytomas sella turcica (31%) of patients with meningioma die should continue to be reported as 9421/3. 227.4 Benign neoplasm of pineal within five years, compared to only sixteen Laterality- beginning with • gland, pineal body percent (16%) for breast cancer. malignant and benign tumors diagnosed in Improvements in understanding 2004, the following sites require a laterality • 237.0 Neoplasm of uncertain the disease and its course, as well as code of 1-4 or 9: behavior of pituitary gland and craniopharyngeal duct advances in treatment, depend on accurate • Cerebral meninges, NOS C70.0 • 237.1 Neoplasm of uncertain data collection. There are many reasons to • Cerebrum C71.0 behavior of pineal gland collect data on benign tumors: • Frontal lobe C71.1 • 237.5 Neoplasm of uncertain • Approximately half of all patients • Temporal lobe C71.2 behavior of brain and spinal cord diagnosed with brain tumors are • Parietal lobe C71.3 • 237.6 Neoplasm of uncertain currently excluded from data collection • Occipital lobe C71.4 behavior of meninges: NOS, cerebral, efforts; it is not possible to monitor the • Olfactory nerve C72.2 impact of this condition on Georgia spinal • Optic nerve C72.3 citizens. • 237.70 Neurofibromatosis, • Acoustic nerve C72.4 • Some benign tumors become malignant Unspecified von Recklinghausen’s • Cranial nerve, NOS C72.5 over time; Disease The research community has • Due to their location and • 237.71* Neurofibromatosis, Type One indicated that the location and laterality for responsiveness to treatment, benign von Recklinghausen’s Disease primary CNS tumors is of significant • 237.72 Neurofibromatosis, Type Two and malignant brain tumors have interest in determining causation and similar prognoses; von Recklinghausen’s Disease assessing the impact on quality of life. • Since causes of brain tumors are not • 237.9 Neoplasm of uncertain Grade-The World Health behavior of other and unspecified parts well understood, studying the etiology Organization (WHO) grade should be of nervous system; cranial nerves of benign brain tumors will improve recorded in Site Specific Factor 1 of the CS our understanding of malignant tumors; It is estimated that reporting system, histological grade will continue to benign and CNS tumors are similar to the The Benign Brain Tumor Cancer be collected as the morphology sixth digit malignant CNS tumors approximately 1% Registries Amendment Act was signed by ‘Grade’. the President in October 2002. Public Law of the total caseload at the central registry. Sequence Number- primary non- However the hospital caseload will be 107-260 requires the collection of benign malignant tumors diagnosed on or after dependent on the type of reporting facility, and central nervous system tumors by the January 1, 2004 should be sequenced in the National Program of Cancer Registries hospitals with small or no neurology service range of 60-87. will likely experience a minimal increase, (NPCR). This law requires all cancer Site/Histology Validation List is however hospitals with a large neurology registries authorized by the Public Law and available in the ICD-O-3 primary brain and funded by the federal government (NPCR service will likely experience a larger CNS site histology list. increase. Reporting facilities need (cont.) Benign CNS Tumors (cont.) The GCCR is planning to conduct directed to your regional coordinator or you training on reporting benign brain and CNS may go to the Ask NAACCR web site at to review the following casefinding sources tumors during our Spring Training April www.naaccr.org/Standards/AskNAACCR.h for identifying these cases: Pathology, 28-30, 2004. You can also find training tml. A panel, including representatives cytology; disease indices; surgery logs; materials on the NAACCR website at from each standard setting organization will diagnostic imaging; radiation oncology; www.naaccr.org or on SEER training web review each question and provide an neurology clinics; medical oncology and site at www.training.seer.cancer.gov. answer. autopsy reports. Inquires regarding the collection of the benign and CNS tumors should be Welcome Wagon The cancer registry profession has Teri’s husband Perry is a police officer in their town and retired 2 a new recruit in its ranks. Teri Carter of Supervisor with the City of LaGrange years ago after 25 years as Lieutenant over LaGrange accepted the offer as the new Water Department and they are planning a the Detective Division. Teri stated that her cancer registrar for West Georgia Health trip to Canada next year to celebrate their mother showed her “that no obstacle is Systems. 30th wedding anniversary. insurmountable if you believe in yourself.” Teri has lived in LaGrange for 46 More immediate celebrations That is sound wisdom for all years, her entire life. A former middle include their only daughter’s wedding cancer registrars and we all welcome Teri school teacher, she has worked in the which will take place in June. Carter to the cancer registry profession. medical field for 5 years coming from Teri enjoys reading, cross-stitch Betty Gentry, RHIT, CTR LaGrange Internal Medicine as a Certified and painting in her spare time. When asked Central Regional Coordinator Medical Assistant before moving to West whom she admired most, she said her Macon Georgia Health System. mother. Her mother was the first female Blue Ribbon Award During the recent CDC/NPCR a very nice conference room reserved for was responsible for all the data being audit, Phoebe Putney Memorial Hospital in the auditor’s use and had all the requested available for the audit. Albany and South Georgia Medical Center records available for their review. As the Southwest Regional in Valdosta were two of the nine hospitals The Pathology Department of both Coordinator, I was very proud of these selected to be part of the audit process. hospitals had hard copies of the path reports hospitals and along with GCCR, GCCS at The Registrars and staff at both of available rather than electronic files, which Emory, and CDC would like to thank these facilities deserve a blue ribbon for made the review much easier. The Medical Phoebe Putney Memorial Hospital and their efforts in having everything in place Records Department at Phoebe retrieved South Georgia Medical Center and tell them for the auditors, which made the audit records from storage for the audit and how much we appreciate their work. process run vary smooth and efficiently. electronic medical records were printed out The auditors commented on how at South Georgia. Carol Crosby, CTR impressed they were with both of these The Registry staff at both facilities Southwest Regional Coordinator facilities and how much they appreciated coordinated the requests of documents and Albany their cooperation and hospitality. Both had HIPAA Corner Adapted from: Hiatt, RA. HIPAA: The End of Epidemiology, or a New Social Contract? Epidemiology. 2003;14:637-639. HIPAA was not intended to interfere with public health and The data collection effort by the AAMC is a systematic and medical research. However, what if there are genuinely deleterious constructive effort to document the HIPAA-related problems for effects? One positive step we can all take is to read and understand research that will be essential to future decision-making. It will help the new privacy regulations. We might need to press for changes in show the burden of compliance, and it could uncover new issues that the regulation. In fact, there are already mechanisms in place to were not considered in the formulation of the current Rule.